Notice
Deficiencies: 0
Nov 20, 2025
Visit Reason
This document serves to inform individuals about the privacy practices of NJDHSS, including how their medical information may be used and disclosed, and their rights regarding this information.
Findings
The notice explains the types of information covered, reasons for use and disclosure of health information, individual rights to access and amend information, and legal duties of NJDHSS to protect privacy.
Report Facts
Effective date: 2011
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Devon L. Graf | Director, Office of Legal and Regulatory Compliance | Listed as NJDHSS Privacy Officer contact for questions about the notice |
Inspection Report
Complaint Investigation
Census: 84
Deficiencies: 0
Jan 27, 2025
Visit Reason
The inspection was conducted in response to a complaint (Complaint # NJ00182622) to assess compliance with regulatory requirements.
Findings
The facility was found to be in substantial compliance with the requirements of 42 CFR Part 483, Subpart B, and the New Jersey Administrative Code, Chapter 8:39, based on this complaint visit.
Complaint Details
Complaint # NJ00182622 was investigated and the facility was found to be in substantial compliance; no deficiencies were cited.
Report Facts
Census: 84
Inspection Report
Routine
Census: 84
Capacity: 112
Deficiencies: 7
Dec 12, 2024
Visit Reason
A routine recertification survey was conducted to determine compliance with 42 CFR Part 483, Requirements for Long Term Care Facilities.
Findings
Deficiencies were cited related to resident rights, safe/comfortable environment, activities, infection control, facility assessment, fire safety, and other regulatory requirements. Corrective actions and plans of correction were documented with completion dates.
Deficiencies (7)
| Description |
|---|
| Failure to ensure residents' rights to dignity and care in a manner promoting their individuality and equal access to quality care. |
| Failure to provide a safe, clean, comfortable, and homelike environment. |
| Failure to provide activities meeting interests and needs of residents. |
| Failure to establish and maintain an infection prevention and control program. |
| Failure to ensure physician visits are timely and documented. |
| Failure to maintain safe environment including fire safety and means of egress. |
| Failure to maintain safe oxygen cylinder storage and labeling. |
Report Facts
Census: 84
Total licensed beds: 112
Deficiency completion dates: Dec 25, 2024
Inspection Report
Routine
Census: 91
Capacity: 112
Deficiencies: 15
Sep 28, 2023
Visit Reason
A routine recertification survey was conducted to determine compliance with 42 CFR Part 483, Requirements for Long Term Care Facilities.
Findings
The facility was found to be in substantial compliance with emergency preparedness requirements but had deficiencies related to resident dignity, environment safety, grievance procedures, staff credentialing, care planning, infection control, staffing, food and diet, resident records, and other regulatory requirements. Corrective actions and plans of correction were documented.
Severity Breakdown
Level 3: 15
Deficiencies (15)
| Description | Severity |
|---|---|
| Failure to treat residents with respect and dignity, including knocking on doors before entering and addressing residents appropriately. | Level 3 |
| Failure to maintain a safe, clean, comfortable, and homelike environment, including issues with roach activity and cleanliness. | Level 3 |
| Failure to maintain an effective grievance policy and process consistent with facility policy. | Level 3 |
| Failure to ensure all employees have current and verified credentials prior to hire. | Level 3 |
| Failure to ensure all grievances are entered on the grievance log and addressed timely. | Level 3 |
| Failure to ensure all residents have comprehensive care plans developed and updated timely. | Level 3 |
| Failure to ensure all discharged residents have a discharge summary completed and available. | Level 3 |
| Failure to provide adequate staffing levels to meet resident needs, including deficient CNA staffing on multiple shifts. | Level 3 |
| Failure to maintain accurate posted nurse staffing data and ensure payroll time clock data is accurate. | Level 3 |
| Failure to ensure all residents receive appropriate dietary preferences and nutritional care. | Level 3 |
| Failure to maintain complete and accurate resident medical records, including physician orders and documentation. | Level 3 |
| Failure to ensure all employees receive required physical exams and TB testing prior to hire. | Level 3 |
| Failure to ensure all employees receive required annual training, including behavioral health and infection control. | Level 3 |
| Failure to ensure all residents receive required immunizations and education. | Level 3 |
| Failure to maintain safe fire safety measures including self-closing fire doors and fire-rated door labels. | Level 3 |
Report Facts
Census: 91
Total Capacity: 112
Sample Size: 19
Deficiency Count: 15
Staffing Deficiency: 14
Staffing Deficiency: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Human Resources Director | Human Resources Director | Named in credentialing and hiring deficiencies |
| Licensed Practical Nurse | Licensed Practical Nurse (LPN) | Interviewed regarding resident care and staffing |
| Director of Nursing | Director of Nursing (DON) | Interviewed regarding staffing, grievances, and care planning |
| Licensed Nursing Home Administrator | Licensed Nursing Home Administrator (LNHA) | Interviewed regarding grievances, staffing, and facility policies |
| Activities Director | Activities Director | Responsible for auditing resident dietary preferences |
| Food Service Director | Food Service Director (FSD) | Interviewed regarding food service and resident dietary issues |
| Human Resource Director | Human Resource Director (HRD) | Interviewed regarding staffing and employee records |
Inspection Report
Complaint Investigation
Census: 93
Deficiencies: 1
May 3, 2023
Visit Reason
The inspection was conducted as a complaint survey based on allegations of abuse, neglect, exploitation, or mistreatment at the facility.
Findings
The facility was found not in compliance with requirements related to reporting alleged violations of abuse or injuries of unknown origin. Specifically, staff failed to immediately report an injury of unknown origin for one resident, Resident #2, as required by facility policy and regulations.
Complaint Details
Complaint # NJ00151843, NJ00162232. The complaint investigation revealed failure to report an injury of unknown origin for Resident #2, which was not reported to administration as required. The injury was later determined to be due to the resident resting on the dining table, not abuse.
Severity Breakdown
SS=D: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to immediately report an injury of unknown origin to facility administration for Resident #2 as required by policy and regulations. | SS=D |
Report Facts
Sample Size: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| LPN #1 | Licensed Practical Nurse | Named in failure to report injury of unknown origin for Resident #2 |
| Director of Nursing | DON | Interviewed regarding reporting procedures and investigation |
| Assistant Director of Nurses | ADON | Conducted audits and interviewed regarding reporting and investigation |
Inspection Report
Complaint Investigation
Census: 81
Deficiencies: 0
Aug 9, 2021
Visit Reason
The inspection visit was conducted in response to complaint #NJ 146287 to assess compliance with regulatory requirements.
Findings
The facility was found to be in substantial compliance with the requirements of 42 CFR Part 483, Subpart B, for long term care facilities based on this complaint visit.
Complaint Details
Complaint # NJ 146287 was investigated and the facility was found to be in substantial compliance.
Report Facts
Sample size: 3
Inspection Report
Annual Inspection
Census: 84
Deficiencies: 2
Jun 23, 2021
Visit Reason
The inspection was conducted to assess compliance with New Jersey Administrative Code standards for licensure of long term care facilities, focusing on staffing ratios and nurse aide certification verification.
Findings
The facility failed to maintain the required minimum direct care staff-to-resident ratios as mandated by New Jersey state law and did not have a system in place to consistently verify nurse aide credentials upon hire.
Deficiencies (2)
| Description |
|---|
| Failure to maintain minimum direct care staff-to-resident ratios as required by New Jersey state law. |
| Failure to have a system in place to ensure nurse aide credentials were consistently verified upon hire. |
Report Facts
Census: 84
Certified Nursing Aides on 7:00 AM - 3:00 PM shift: 7
Certified Nursing Aides on 3:00 PM - 11:00 PM shift: 5
Certified Nursing Aides on 11:00 PM - 7:00 AM shift: 4
Residents per CNA on 7:00 AM - 3:00 PM shift: 12
Residents per CNA on 3:00 PM - 11:00 PM shift: 16.8
Residents per CNA on 11:00 PM - 7:00 AM shift: 21
Inspection Report
Complaint Investigation
Census: 77
Deficiencies: 0
May 14, 2021
Visit Reason
The inspection visit was conducted in response to a complaint identified as NJ140556.
Findings
The facility was found to be in substantial compliance with the requirements of 42 CFR Part 483, Subpart B, for long term care facilities based on this complaint visit.
Complaint Details
Complaint number NJ140556 was investigated and the facility was found to be in substantial compliance.
Report Facts
Sample Size: 3
Loading inspection reports...
